Ultrasound, abdomen at CHI Health Good Samaritan. CPT 76700.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$811cash price (self-pay)
$1,329list price
$86.61–$1,236range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid|All Plans | $86.61 |
| Centene | Medicaid|IA Total Care | $86.61 |
| IAMolina | Medicaid|All Plans | $88.31 |
| BCBS - NE | Medicare|All Plans | $101 |
| Humana | Medicare|All Plans | $101 |
| Medica | Medicare|All Plans | $101 |
| PACE | Medicare|All Plans | $101 |
| United | Medicare|All Plans | $101 |
| Centene | Medicare|All Plans | $104 |
| Amerigroup | Medicare|All Plans | $106 |
| Great Plains | Medicare|All Plans | $106 |
| Medica | Commercial|ACO | $148 |
| AMPS | Commercial|All Plans | $224 |
| Medica | Commercial|CHI Health | $226 |
| Medica | Commercial|All Other Plans | $237 |
| United | Medicaid|Community Plan | $279 |
| Centene | Medicaid|NE Total Care | $282 |
| Greater Omaha Packing | Commercial|Narrow Network | $556 |
| Millard Public Schools | Commercial|Narrow Network | $556 |
| One World | Commercial|Narrow Network | $556 |
| Greater Omaha Packing | Commercial|Broad Network | $640 |
| Millard Public Schools | Commercial|Broad Network | $640 |
| One World | Commercial|Broad Network | $640 |
| Timpte | Commercial|Broad Network | $640 |
| Creighton University Employees | Commercial|All Plans | $651 |
| ELAP | Commercial|All Plans | $771 |
| United | Commercial|All Plans | $1,010 |
| Medica | Commercial|Open Access | $1,037 |
| Midlands Choice | Commercial|Premier | $1,037 |
| Midlands Choice | Commercial|Standard | $1,223 |
Inpatient
$811cash price (self-pay)
$1,329list price
$651–$1,236range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Creighton University Employees | Commercial|All Plans | $651 |
| United | Commercial|All Plans | $1,010 |
| Medica | Commercial|Open Access | $1,037 |
| Midlands Choice | Commercial|Premier | $1,037 |
| Midlands Choice | Commercial|Standard | $1,223 |
| MultiPlan PHCS | Commercial|All Plans | $1,236 |
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